How do I tell chest-wall pain from a heart attack?

Chest-wall pain is usually sharp, in one spot, sore when you press it, and worse when you move or breathe deeply. Heart pain is more often a central tightness or pressure you cannot pinpoint, may spread to the arm or jaw, and comes with breathlessness, sweating or nausea. This is a rough guide only - if in any doubt, call 995.

My rib pain is worse when I breathe in - is that dangerous?

Pain worse on breathing (pleuritic pain) can be a strained muscle or costochondritis, but it can also signal a lung problem such as a clot, infection or collapsed lung. If it came on suddenly with breathlessness, or with fever or coughing up blood, treat it as an emergency and call 995. Otherwise get it checked promptly.

I have burning pain on one side of my chest but no rash - what could it be?

One-sided burning or band-like pain can be the first sign of shingles, which can start days before the rash appears. See a doctor soon, as antiviral treatment works best when started early. If the pain has features of cardiac or lung causes, seek urgent care instead.

How long does costochondritis take to settle?

It often eases over a few weeks and can take a couple of months to fully settle. Rest, gentle movement and over-the-counter pain relief usually help. See a doctor if it is not improving, keeps returning, or any red-flag feature appears - and call 995 for central, spreading or breathless chest pain.

Rib and Chest-Wall Pain: Causes and When to Worry (Singapore)

Written & reviewed by the BestDoctors.sg editorial team · Last updated 29 Aug 2026 · General information, not medical advice

Quick answer. Most rib and chest-wall pain comes from the ribs, the cartilage joining them to the breastbone, or the chest muscles – commonly costochondritis or a muscle strain – and is usually sharp, localised, sore when you press on it, and worse on moving or breathing. It generally settles over weeks. The vital job is to tell this from cardiac chest pain and lung causes. Call 995 if pain is a central tightness, pressure or squeezing, spreads to the arm, neck or jaw, or comes with breathlessness, sweating or nausea, or if you have sudden breathlessness with sharp pain worse on breathing. When in doubt, treat chest pain as an emergency. This is general information, not a diagnosis.

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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.

Where chest-wall pain comes from

Chest-wall pain means pain from the structures of the chest wall itself – the ribs, the cartilage that joins them to the breastbone, the muscles between and over the ribs, and the nerves running along them – rather than from the heart or lungs. The most important task of this guide is to help you tell musculoskeletal chest-wall pain apart from cardiac and lung causes, because the safe response differs. Typical chest-wall pain can usually be reproduced by pressing on the sore spot and is worse on twisting or deep breaths. This is a helpful guide, not a test – being able to press on a sore spot does not prove the heart is fine – so any doubt means seeking urgent help.

Common causes

The frequent, benign causes are musculoskeletal. Costochondritis is inflammation where the ribs meet the breastbone cartilage: sharp pain at the front or side of the chest, worse on movement, deep breathing or pressing, that settles on its own over weeks to a couple of months. Tietze syndrome is a similar problem with visible swelling of the cartilage. A muscle strain of the chest wall follows coughing bouts, lifting or awkward movement. A bruised or cracked rib after a fall, blow or heavy coughing is sharply painful to breathe or press and needs assessment. Shingles can cause a burning, band-like pain on one side that may precede the rash by days.

The serious causes to exclude

Several serious problems can feel like rib pain. Cardiac pain (a heart attack or angina) is more often a central pressure, tightness or squeezing that you cannot pinpoint or press on, may spread to the arm, jaw, neck or back, and comes with breathlessness, sweating or nausea – this is the priority to exclude. Pleuritic pain, which is worse on breathing in, can signal a lung problem: a clot on the lung (pulmonary embolism), a chest infection or pleurisy, or a collapsed lung (pneumothorax). A sudden, severe “tearing” pain going through to the back is a rare but dangerous emergency. Reflux, anxiety and pericarditis can also cause chest pain. This range is why unexplained chest pain should always be checked.

When rib pain is an emergency (call 995)

Call 995 and do not drive yourself if chest pain is crushing, tight, heavy, squeezing or a pressure, especially central and persistent; if it spreads to the arm, neck, jaw, back or stomach; or if it comes with breathlessness, sweating, nausea, light-headedness or looking grey and clammy – a possible heart attack. Also call 995 for sudden breathlessness with sharp chest pain worse on breathing in, with or without coughing up blood (a possible clot on the lung or collapsed lung); for sudden severe tearing chest or back pain; or for chest pain after a significant injury with breathlessness or feeling faint. When unsure, treat chest pain as an emergency – it is safer to be checked.

When to see a doctor soon

Some chest-wall pain is urgent but not an emergency. See a doctor the same day, or go to A&E, for rib pain after a fall or blow that is severe, comes with breathlessness, or gives a crunching feeling (to check for a fracture or underlying injury); for fever with chest pain and a productive cough (a possible chest infection); or for a new one-sided burning or band-like pain, especially if a rash appears, as shingles is treated best early. On a routine basis, see a GP for localised, reproducible chest-wall pain with no red flags that is persistent or not improving, or recurrent brief pains you would like assessed for reassurance.

Safe self-care

Only once cardiac and lung causes are not a concern – no red flags – is self-care appropriate for a strain or costochondritis. Rest from aggravating activities and avoid heavy lifting or movements that flare the pain, but keep gently moving rather than staying rigidly still. Heat or a cold pack on the sore area can give comfort, and supporting the chest with a pillow eases coughing or sneezing after a strain. For pain relief, simple analgesics or anti-inflammatory painkillers may help costochondritis and strains – by class only; ask a pharmacist, as anti-inflammatories do not suit everyone. Never use painkillers to push through pain that is central, spreading, or comes with breathlessness – that is an emergency.

Getting it checked

A doctor’s first job is to make sure the pain is not coming from the heart or lungs. They will ask what the pain is like, what it comes with, and whether pressing on the chest reproduces it, and examine you; where needed they may arrange heart tracings, blood tests or a chest X-ray. Musculoskeletal chest-wall pain such as costochondritis is often diagnosed once serious causes are excluded, and usually needs no further tests. In Singapore, anyone with a possible cardiac or lung emergency should go to a hospital A&E; a GP or polyclinic can assess milder, clearly musculoskeletal pain and advise on recovery.

Reducing your risk and recovery

Costochondritis and chest-wall strains generally improve over a few weeks and can take a couple of months to settle fully, helped by rest, gentle movement and simple pain relief. To reduce recurrences, warm up before exercise, use good technique when lifting, and treat coughs that are straining the chest. Looking after general heart health – not smoking, staying active, and managing blood pressure, cholesterol and diabetes – is worthwhile given how important it is not to miss cardiac pain. See a doctor if chest-wall pain is not improving, keeps returning, or if any red-flag feature appears, and never hesitate to call 995 if pain becomes central, spreading or breathless.

Related pain & joint topics

Sources

NHS – Costochondritis: nhs.uk
NHS – Chest pain: nhs.uk
NHS – Heart attack: nhs.uk
NHS – Deep vein thrombosis (DVT): nhs.uk

General information only. This guide helps you understand possible causes of pain in this area – it does not diagnose your pain or replace advice from a doctor. Call 995 or go to A&E if pain in the arm or chest wall comes with chest tightness, breathlessness, sweating or jaw pain (possible heart attack), if you have sudden breathlessness with sharp chest pain, if one leg becomes swollen, warm and tender (possible clot), if you have severe pain with numbness or tightness after an injury, or if back or buttock pain comes with numbness around the groin or new bladder or bowel problems (a spinal emergency). See a doctor promptly for pain after a significant injury, a hot swollen joint with fever, or pain with unexplained weight loss, night pain or fever. Do not exceed the dose guidance on any pain-relief medicine, and check with a pharmacist or doctor if unsure.

Rib & Chest-Wall Pain